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Q&A: Malnutrition and emergencies

February 2017

What are malnutrition and starvation?

Malnutrition comes in many forms. Simply put, it means poor nutrition. It includes:

undernutrition: when a person does not get enough food to eat, causing them to be wasted (this is also called acute malnutrition, when someone is too thin for their height) and/or stunted (this is also called chronic malnutrition, when someone is too short for their age). Undernutrition increases the risk of infectious diseases like diarrhoea, measles, malaria and pneumonia, and chronic malnutrition can impair a young child’s physical and mental development.

micronutrient deficiencies: when a person does not get enough important vitamins and minerals in their diet. Micronutrient deficiencies can lead to poor health and development, particularly in children and pregnant women.

overweight and obesity: linked to an unbalanced or unhealthy diet resulting in eating too many calories and often associated with lack of exercise. Overweight and obesity can lead to diet-related noncommunicable diseases such as heart disease, high blood pressure (hypertension), stroke, diabetes and cancer.

Starvation is a severe lack of food which can result in death.

How big a problem is malnutrition in emergencies?

In emergencies, people are at higher risk of undernutrition and micronutrient deficiencies. Those whose nutrition was poor before the crisis are even more vulnerable. Acute malnutrition weakens the immune system, which then becomes more susceptible to developing diseases that can be fatal.

Undernutrition and micronutrient deficiencies can be widespread among refugees and displaced people, as adequate food and health services are often not readily accessible.

Inadequate nutrition and repeated bouts of infection during the first 1000 days of a child’s life can cause stunting, which has irreversible long-term effects on the physical and mental development of children. Worldwide in 2015, there were 156 million stunted children, about 45% of them living in fragile and conflict-affected countries.

Emergencies can also aggravate diet-related noncommunicable disease, such as heart disease, high blood pressure (hypertension), diabetes and cancer. Healthy foods may not be regularly available and appropriate medical care may not be accessible, leading to the interruption or cessation of treatments for these diseases. Given that many populations have high levels of noncommunicable diseases, emergencies can cause a significant increase in illness and even death from these diseases.

Who is most vulnerable to undernutrition and starvation during emergencies?

Young children and women who are pregnant or breastfeeding are most vulnerable to undernutrition. Their bodies have a greater need for nutrients, such as vitamins and minerals, and are more susceptible to the harmful consequences of deficiencies.

Children are at the highest risk of dying from starvation. They become undernourished faster than adults. Severely wasted children are 11 times more likely to die than those with a healthy weight. Undernourished children catch infections more easily and have a harder time recovering because their immune systems are impaired. Globally, undernutrition is an underlying factor in more than half of child deaths from pneumonia and malaria, and more than 40% of measles deaths.

How should severe acute malnutrition be treated in an emergency?

Severe acute malnutrition is when a person is extremely thin and at risk of dying. They need immediate treatment. The response to acute malnutrition is broad and includes several elements such as medical, food, water and hygiene, and social services.

Children who still have an appetite can stay at home and receive outpatient care. They need treatment with specially-formulated foods, and their recovery must be monitored regularly by a trained health worker.

Children who have medical problems and do not have an appetite need inpatient care in a clinic or hospital. They need specially-formulated milks and treatment for infections or other potential complications.

Why is it so important for infants to breastfeed during emergencies?

Breastfeeding can be life-saving for young children in emergencies.

Breastfeeding in all environments has major health benefits for both children and mothers. Breast milk gives infants all the nutrients they need for healthy growth and development. It is readily available and contains antibodies that protect infants from common childhood illnesses. Breastfeeding also reduces mothers’ risks of breast and ovarian cancer, type II diabetes, and postpartum depression.

Breastfeeding becomes even more critical for child survival in humanitarian emergencies. Young children in emergencies face higher risks of diarrhoea, pneumonia and undernutrition. Lack of food, unsafe water, poor sanitation, overcrowding and overburdened health systems put infants and young children at greater risk.

WHO recommends that all babies should be fed only breast milk for the first 6 months, after which they should continue breastfeeding (as well as eating other foods) until 2 years of age, and potentially for longer, even in emergency situations.

What are the challenges to breastfeeding in emergency situations?

Often the poor physical and mental health of mothers in emergencies leads to poor breastfeeding outcomes. Displaced mothers may struggle to find comfortable, private places to breastfeed and their support network of family and friends is often not accessible in emergencies. Health workers who would usually offer support may be redeployed to cope with other aspects of the emergency response.

Well-meaning donors may distribute breast-milk substitutes (such as infant formula) in emergencies. This can undermine breastfeeding and, if there is a lack of clean water to make formula or clean bottles and teats, put children at increased risk of infections which can be deadly.

Governments and humanitarian organizations have a key role to play in protecting, promoting and supporting breastfeeding in emergencies.